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Common Sense on Covid and the Death Rate

Common Sense on Covid and the Death Rate
There are many facts and opinions swirling around about the virus, the response, and everything in between. There is a lot of virus-denialism that appears more rooted in wishful thinking than a considerations of the facts. The wisdom of shutting down the economy is questioned; a quite legitimate issue in a democracy. And the very nature of the virus is up for grabs. Unfortunately so much of the commentary and quick-takes that I come across on social media and get cc’ed on by email are built of highly selective cherry picking (or nit-picking) of individual facts, and don’t take the whole picture into consideration. This is not easily addressed, since so much of the data is incomplete, and so many important variables remain unknown. However, it is possible to sketch out the big picture. We love numbers. But reality is really tricky to quantify, especially the closer you look. And especially if you have really bad data. And when it comes to SARS-CoV-2 in the US we have really bad data. Because we have so few Covid-19 tests. And we don’t really know how accurate they are. And because people die of a wide variety of causes every day anyway. Which makes saying anything precise about Covid-19 and the SARS-CoV-2 virus really difficult. The death rate of Covid-19 is just a wild guess. Because we don’t know how many people actually have it (in the US or in most of the world). Because we aren’t widely testing. Germany is widely testing. Their death rate is way lower than other countries. But that is probably because they are testing everyone, and so they catch all the mild and asymptomatic cases and include these in the count, whereas in the US you can’t get a test unless you are moderately to severely ill and in a hospital already. So the US has a much higher percentage of tested patients dying, and thus an artificially inflated death rate. But such quibbles about the statistics represent clever people getting lost in the weeds; losing sight of the forest for the trees. The forest looks like this: The statistics I’ve seen have the Covid-19 death rate for people under 55 at about 0.8%, or about 4x higher than the seasonal flu. Not so bad. Except that 75% of the US population is under 55. That’s 245 million people. If they all got the virus in a two-month period that is 1,960,000 deaths. Divide that number in half if you think only half the population gets it. Divide it in half again. And again, just because. That is still 245,000 deaths, and that is just the under 55’s; you still have to add the quarter of the population who are over 55 and are much more susceptible. In a typical year about 2.8 million people in the US die of all causes, or about 230,000 per month. And our profit-optimized health system runs at about 85% capacity. You can’t add 100,000+ per month to that without utter chaos, even if 96% of the under-55 population doesn’t need hospitalization. Which is why so many people are calling for physical distancing and shutting down public gatherings. Some people try to dispute the death statistics around Covid-19 by pointing out that just because someone died in a hospital and had the SARS-CoV-2 virus present doesn’t mean that the virus killed them. And this is true. But largely besides the point. Even if a significant number of people who are on the Covid-19 death count would have died anyway, it is the marginal quantity that make this a crisis for the medical system. The marginal ones (economics term for the extra ones beyond what you would have had anyway) don’t have to be a particularly large number to be a problem. They start to stress the system. And they only have to be 20% of the total cases (let’s say that 80% would have died that week anyway) for the extra ones to overload the system. For individual people at the edge of death anyway, it may not matter if they die now or in October. But for the medical system it matters a whole lot if they ALL die during the next month. Why? Once hospitals are full of Covid-19 patients they can’t see other types of patients. Or even moderately ill Covid-19 patients who would otherwise survive with moderate treatment. They are out of capacity. In plain terms, people who otherwise would have been saved will die of both Covid-19 and other causes. Some of them will be young. And/or rich. And they would have lived for years if the hospital wasn’t over-full. Understanding that, and the full scale of the pandemic, the smart folks are all advocating physical distancing. So in the end the forest is that most healthy people will be fine. But enough people (both healthy and otherwise) will need intensive care that it is would be utter bedlam in the health care system for months had we all gone about as normal; crisis would have been so acute that millions would have died in a span of a couple months, and many of those would have been from other, preventable causes. With physical distancing having been taken up in much of the US for weeks already, it will still be pandemonium in the health care system for a long time, but the number of non-covid preventable deaths should be a lot lower. Those millions will still die, but it will be spread out over many months, even years, and in the meanwhile the non-covid illnesses can continue to be treated. In the end, both of these considerations can be simultaneously true: the virus is not a big deal because 96% of healthy people will not need to be hospitalized, and at the same time Covid creates epidemic outbreaks so severe that the cost in human life is so high that there is a strong case for shutting everything down even at enormous financial and social cost. Overly focusing on one part while ignoring the other is selectively picking facts, and is usually the result of confirmation bias.

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